Figure 32-24 Normal central venous pressure (CVP) waveform. The diastolic components (y descent, end-diastolic a wave) and the systolic components (c wave, x descent, end-systolic v wave) are all clearly delineated. A mid-diastolic plateau wave, the h wave, is also seen because the heart rate is slow. Identification of the waveform is aided by timing the relationship between individual waveform components and the electrocardiographic R wave. Timing of the waveform with the arterial pressure (ART) trace is more confusing because of the relative delay in systolic arterial pressure upstroke. (Redrawn from Mark JB: Atlas of Cardiovascular Monitoring. New York, Churchill Livingstone, 1998, Fig. 2-5.)